Bariatric surgery

It is estimated that more than 5% of US adults are morbidly obese (body mass index higher than 40). Morbid obesity is associated with adverse health conditions including prolonged morbidity and early mortality while affecting people of lower socioeconomic means. A variety of surgical procedures have evolved over the past 30 years to address this problem with varying degrees of success and longevity. For those patients achieving dramatic weight loss, reconstructive cosmetic surgery is often necessary or desirable. Techniques to achieve this are described.     

Endometriosis in pediatric and adolescent gynecology

Endometriosis is the most common cause of chronic pelvic pain in adolescent girls (50-70%), unresponsive to treatment of oral contraceptives and non-steroidal anti-inflammatory drugs. The most common symptoms of the disease are: acquired or progressive dysmenorrhea, acyclic and cyclic pain, dyspareunia (in sexually active girls), urological symptoms and gastrointestinal complaints. When evaluating an adolescent with suspected endometriosis, a gynecological examination (rectal or vaginal examination) and imaging studies (ultrasonography, magnetic resonance) should be performed. Moreover, in diagnostic process laparoscopy should be carried out in all girls and teenagers with chronic pelvic pain unresponsive to medical treatment. Initial therapy of endometriosis in adolescent girls involves: surgical methods (laparoscopy/laparotomy), hormonal pharmacotherapy (combined contraceptives, progestin-only protocols), GnRH agonists (adolescents over 16 years of age), non-steroidal anti-inflammatory drugs, alternative pain therapies and psychotherapy. Early diagnosis and treatment during adolescence may decrease disease progression and prevent subsequent infertility.     

Communicating with the adolescent gynecology patient

Providing health care to adolescents begins with good communication. Teens appreciate providers who are genuine and not parental. Guidelines to facilitate adolescent communication are presented. A good dialogue with teens can initiate a lifetime of care.     

Bariatric surgery and subsequent sexual function

The purpose of this article is to appraise the literature and provide an analysis to determine whether weight loss by bariatric surgery has a positive or negative impact on sexual function in both male and female patients.     

Expressive therapy in pediatric and adolescent gynecology.

Children and adolescents seen by gynecologists may have a broad spectrum of emotional needs that can affect the gynecologic examination as well as the young person's overall well-being. The field of expressive therapy is a relatively new one. The therapist uses a variety of techniques to allow the patient to explore feelings, attitudes, or events in ways that may help the patient to develop new strategies to cope with distress. The application of expressive therapy in pediatric and adolescent gynecology appears to be ever more encompassing.     

Robotic surgery in gynecology

Robotic technology is nothing more than an enhancement along the continuum of laparoscopic technological advances and represents only the beginning of numerous more forthcoming advances. It constitutes a major improvement in the efficiency, accuracy, ease, and comfort associated with the performance of laparoscopic operations. Instrument articulation, downscaling of movements, absence of tremor, 3-D image, and comfort for the surgeon, assistant and scrub nurse are all new to the practice of laparoscopy. In our hands, robotic operative times for simple and radical hysterectomy are shorter than those obtained by conventional laparoscopy. Robotic technology is preferable to conventional laparoscopic instrumentation for the surgical treatment of gynecologic malignancies and most operations for benign disease of certain complexity such as hysterectomy myomectomy, and invasive pelvic endometriosis.     

Polycystic ovary syndrome in adolescent gynecology]

PCO syndrome is a chronic hyperandrogenic disorder beginning in adrenarche. We tried to find a PCO share in general hyperandrogenic population of adolescent girls regarding hormonal and usg parameters. We found LH v FSH ratio > 2:1 as sensitive feature of PCO for most of the patients then other clinical and endocrinological criteria.